Sleep paralysis is a temporary state of the body that occurs at the border between sleep and reality. It is manifested by the onset of muscle atonia before the transition to sleep, as well as the awakening of consciousness before muscle tone is restored. A synonym for the condition is the term “sleepy stupor.”
The state of sleepy stupor is not a very rare deviation. Most often, this trouble happens to patients suffering from irresistible daytime sleepiness (narcolepsy). Muscle paralysis or loss of tone is usually accompanied by strong hallucinations that frighten the person, to which he cannot react properly due to stupor.
What do the statistics show?
The question of what causes sleep paralysis is under study. According to general statistics, approximately 7% of the population has experienced sleep paralysis at least once during their life. Students are more susceptible to it (28.3%). It has been hypothesized that the nature of such muscle paralysis may be due to irregular sleep or prolonged exposure to stress.
Data obtained from a study of the health of students show that 75% of students who experienced a state of sleep paralysis had at least one case of hallucinations at this moment. About 10% of respondents reported a frequency of hallucinatory visions of 3 or more times. 90% of students who were in a state of sleep atony experienced a strong feeling of fear and horror when falling asleep.
This sleep disorder occurs in the fairer sex 1-2% more often than in the stronger sex. Since the difference is insignificant, it means that the risk of developing sleepy stupor does not depend on gender. Sleep paralysis can also occur in children.
Patients with psychiatric diagnoses usually suffer from insomnia atony: it developed in 31.9% of such patients. Among patients diagnosed with panic disorder syndrome, sleepy stupor occurred in 35%.
Bruxism: “I ‘ate’ a mouthguard in a month”
Patients most often come to us from dentists with a diagnosis of bruxism (night grinding of teeth). There are two theories about the origin of the disease. The first is dental, associated with malocclusion. The second is neurogenic, caused by the influence of the central and peripheral nervous systems. According to research, 10-15% of adults and about 30% of children suffer from bruxism. For some reason (as determined by doctors), the chewing muscles begin to move at night, which causes tooth enamel to wear off.
In our practice, in 90% of cases the cause of this illness is psychosomatics
(for example, accumulated stress or very strong experiences), or it is a pathology of the cerebral cortex (bruxism can be the equivalent of nocturnal epilepsy).
Depending on the genesis of the disease, we can precisely prescribe the drug, and often people feel significant improvements within a couple of days or weeks.
Just recently, a patient came to me who complained of temporomandibular joint dysfunction, pain in the jaw area, and dental problems. For a long time she went to the maxillofacial surgeon and dentist. They decided that the problem was related to incorrect biomechanics in the jaw, and offered to replace 12 teeth with prosthetics. That is, a young girl, roughly speaking, had 12 teeth pulled out and 12 implants installed.
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After that, within a month, she erased these implants in her sleep. They added enamel to her and suggested she sleep with a mouthguard. The mouth guard was “eaten up” within a month on average (for reference: one mouth guard costs about $250). A year passed and she contacted me. We diagnosed bruxism with adjustment disorder: the girl had serious stress at work and in the family, which provoked and maintained this condition. They prescribed medications for the night, completely removed the elements of bruxism - the load on the jaw decreased after just a few days. The patient, of course, was happy, but was only worried that she had wasted so much nerves, health and money. During this time, she spent about $20 thousand on dental services, and in the end the treatment cost about 50 rubles.
Development mechanism
Sleep as a physiological process consists of two phases: slow and fast. First comes the slow phase, then the fast phase, characterized by a drop in skeletal muscle tone. Breathing cycles become more frequent and inhalations become shorter. Brain activity during sleep increases to the level characteristic of the waking state.
In the case of a sleep disorder, the sequence of processes is confused, so a person becomes conscious before muscle tone normalizes. A feeling of immobility appears - this is sleepy stupor (paralysis, muscle atony).
This can happen during the transition to sleep: REM sleep has already begun, but consciousness has not yet switched off. A sleeping person cannot take a deep breath (after all, in the REM sleep phase, short and frequent breaths are reflexively taken). There is a feeling of tightness in the chest.
The feeling that you can't move is a symptom that signals danger to the nervous system
In response, there is a huge release of neurotransmitters, as a result, the person experiences fear, anxiety, and hallucinations. It seems to him that he is gliding in the air, because the vestibular apparatus is working, but does not receive feedback from peripheral organs due to immobility.
Night eating syndrome: “Woke up covered in mayonnaise and didn’t remember anything”
Let's go further and talk about night eating syndrome. True, we must distinguish it from the state known to many, when you wake up at night and just go eat because you feel hungry. With night eating syndrome, a person wakes up at night and cannot help but go and eat. The desire is so strong that he rather feels like a zombie.
Most often, girls and women who try to lose weight and torture themselves with diets
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At night, some of them, driven to extremes, go and absorb everything, but mainly those foods that they forbade themselves to eat. At the same time, they do not remember how it all happened, and when they wake up in the morning, they are surprised to find some food items missing. Sometimes they can wake up stained with mayonnaise
, leftover food and wonder how all this appeared on them.
One of my patients gained a lot of weight after pregnancy and decided to fight it radically, with a super-strict diet, literally to the point of exhaustion. And then she started having episodes of night eating syndrome. She didn’t believe what was happening, she accused her husband of “eating” from the refrigerator at night - he even had to make a video to prove to her otherwise. When the girl switched to a gentle diet, very soon the nightly “raids” for food stopped.
Classification
Based on the time of occurrence of attacks (before waking up or during the period of falling asleep), sleepy stupor is divided into two types.
- Hypnagogic stupor. Characteristic of the moment of falling asleep. It is a rare occurrence. Caused by the onset of REM sleep before the loss of consciousness. Before going to bed, a person feels immobilized.
- Hypnopompic stupor. Develops at the moment of awakening. It is the most common type of this sleep disorder. Sleep paralysis is caused by the inclusion of consciousness while maintaining the low muscle tone inherent in the rapid phase of sleep. Such stupor is combined with vivid emotional shocks and fears that cannot be avoided.
Causes of pathology
Most often, sleep paralysis occurs when a person falls asleep on their back or right side. It can only happen if a person wakes up on his own - forced awakening or sharp sounds always lead to a complete interruption of sleep.
Attacks are provoked by the following factors:
- moving between time zones, leading to a disruption in the biological rhythms that regulate sleep - the risk of sleep paralysis will drop sharply after a short period of adaptation;
- restless sleep associated with stress and various experiences;
- lack of sleep;
- addictions - drugs, nicotine, alcohol, gambling and others that do not allow a person to completely relax;
- restless legs syndrome;
- psychiatric diseases;
- hormonal imbalances;
- taking antidepressants, neurostimulants.
There is also an assumption about the hereditary nature of sleep paralysis. Researchers know of entire families who suffer from repeated attacks of this condition from generation to generation.
Causes of sleep paralysis
Sleep paralysis is based on a violation of the order of waking up (or falling asleep) and muscle atonia, characteristic of the REM sleep phase. The causes of the pathology have not been fully elucidated. Among the predisposing factors, 5 groups are distinguished.
Sleep disorders
Insomnia and irresistible sleepiness (narcolepsy) during the day are fraught with the development of other somnological disorders. Constant violations of the daily routine, chronic lack of sleep, and frequent and rapid changes in time zones act in the same way.
Psycho-emotional stress
Disorders of the circadian sleep-wake cycle can be caused by stress - acute or chronic. Patients suffering from sleep paralysis experience an increase in the number of attacks due to mental overload.
Toxic effects on the central nervous system
Long-term use of certain medications, substance abuse, drug use, alcohol, nicotine addiction is a chronic intake of toxic substances into the body, which has an adverse effect on the function of the central nervous system. As a result, the functioning of the nerve structures regulating the somnological cycle can quickly be disrupted.
Sleeping on your back
Sleeping on your side does not cause attacks of muscle atony. This connection between posture and the insomnia in question still has no explanation. Often a person who changes their sleeping position gets rid of sleep paralysis forever.
Sleep paralysis occurs mainly in people who sleep on their backs
Heredity
Cases of pathology in members of the same family are described. But the genetic basis of the pathology is not fully understood.
According to global data, up to 88% of patients with COVID-19 suffer from insomnia. In addition, 30% of medical staff experience sleep disturbances associated with working under coronavirus conditions. The prevalence of sleep disturbances during the second and third waves ranged from 3% to 88%. Moreover, patients suffered more (74.8%), health workers - 36%, and the population as a whole - 32.3%. Patients with COVID-19 experienced difficulty sleeping during the acute period, as well as insomnia, depression, and anxiety 6 months later.
In an interview with MV, the head of the neurological department of the Republican Medical Center of the Administration of the President of the Republic of Belarus, neurologist-somnologist, candidate of medical sciences. Sciences, Associate Professor Natalia Chechik told what to look for when diagnosing and treating sleep disorders, including those arising against the background of COVID-19.
Natalia Chechik, head of the neurological department of the Republican Medical Center of the Administration of the President of the Republic of Belarus, neurologist-somnologist, candidate of medical sciences. Sciences, Associate Professor. Natalia Mikhailovna, when can you say that a patient has insomnia? What does healthy sleep mean?
Insomnia, or insomnia, is a sleep disorder associated with the inability to either start it, or maintain it properly, or feel the restorative effect of sleep. With insomnia, a person does not sleep at least three nights a week for three months.
Insomnia can be acute or chronic. Acute appears, as a rule, as a reaction to stress and ends after a short course of treatment. It is recommended to maintain a sleep schedule and hygiene. Sedatives (prescription and over-the-counter) and behavioral therapy are prescribed.
Acute insomnia often heals on its own, without medication, and disappears along with the stress that caused it. But if this condition lasts more than 3 months (stress, provoking and supporting factors persist), insomnia becomes chronic, and comorbid disorders are clinically added: unstable blood pressure, heart pain, headaches, etc. The classification of insomnia includes about 50 different forms of chronic insomnia.
The duration of healthy sleep for an adult is 7–8 hours. Normal 8-hour sleep consists of 4–6 cycles, each 90 minutes long, each cycle contains 2 phases: fast (15–25% of total sleep) and slow (75–85%) sleep.
In the REM sleep phase, we dream and realize our emotions. During this phase, information received by the brain during wakefulness is processed, memory mechanisms are activated, the emotional sphere is stabilized, etc.
During deep sleep, the energy reserves of the brain and the body as a whole are restored, proteins, hormones, and enzymes are synthesized. Sleep is the body’s recovery process, and its deficiency causes cognitive, metabolic, hormonal disorders, and increased stress levels.
Why does insomnia occur, what are the causes and features of sleep disturbance with COVID-19?
The main cause of insomnia is hyperactivation. If it is associated with brain disorders, it is called cortical, if with a disease of the autonomic nervous system - sympathetic, if with hormonal disorders of the thyroid gland - endocrine.
Emotional hyperactivation is associated with anxiety, internal tension, fears; cognitive hyperactivation is associated with obsessive thoughts; behavioral hyperactivation is associated with sleep hygiene disorders, sleep deprivation, shift work, and jet lag. Hyperactivation can be secondary, i.e., occur in mental disorders (anxiety, depression, affective), chronic pain syndrome.
One of the main reasons for the development of insomnia is a decrease in melatonin synthesis. In modern conditions, this is facilitated by artificial lighting, shift work, changing time zones during the day, taking certain medications, and various diseases.
By the way, the functions of melatonin are not limited to sleeping pills. This hormone provides regulation of biorhythms, normalization of blood pressure, reduces myocardial energy costs, normalizes gastric motility and secretion, regulates the functioning of the endocrine system, has an antidepressant effect, has anti-cancer properties, and also helps strengthen the immune system. When the amount of melatonin decreases, the production of T-lymphocytes, T-killers that kill the infection, also decreases, and accordingly, antiviral immunity is weakened.
With age, melatonin synthesis decreases. There are suggestions that this may explain why people over 65 are more susceptible to contracting COVID-19.
If we talk about insomnia against the background of COVID-19, then to this day in somnology the question remains open about the connection between the incidence of coronavirus (viral load), acute respiratory distress syndrome and sleep disorders, since symptoms in clinical practice do not always fit into the logic of cause. investigative connections. Based on the literature data and our own observations, two causes of insomnia can be distinguished.
The first is psychological - stress, anxiety, fear of illness, loneliness and lack of support from loved ones during isolation. The second reason is directly related to viral damage to the brain and central nervous system (CNS). One of the components of this damage is the impact on the hypothalamic-pituitary-adrenal system, which produces hormones that protect us from stress. In addition, the virus affects the structures responsible for sleep itself - the reticular formation, subcortical nuclei, and nuclei of the brain stem.
The virus can reach the central nervous system through the nasal as well as hematogenous routes. Subsequent secretion of immunological mediators is accompanied by excitatory reactions from the nervous and endocrine systems. Also, during illness, the brain experiences intoxication - the cortical cause of insomnia. Intoxication causes increased drowsiness and lethargy: a person sleeps during the day but cannot sleep at night, and as a result, circadian rhythms are disrupted. On the other hand, pain syndromes and headaches occur, which in turn also disturb sleep.
Besides insomnia, are you experiencing any other sleep disorders due to COVID-19?
As a complication of coronavirus infection, dangerous conditions with breathing disorders develop - obstructive and central sleep apnea. Obstructive sleep apnea syndrome (OSA) is characterized by snoring, periodic collapse of the upper airway at the level of the pharynx and cessation of pulmonary ventilation with continued respiratory effort, decreased blood oxygen levels, severe sleep fragmentation and excessive daytime sleepiness.
Central sleep apnea occurs due to damage to the respiratory center. Sleep apnea syndrome causes gas exchange disturbances, hypoxia, hypoxemia, deterioration of oxygenation of the brain and heart, and determines the severity of cardiac and vascular diseases, and cognitive impairment. OSA is a risk factor for the development of heart and brain infarctions, sudden death syndrome during sleep due to cardiac arrhythmias.
Another complication of COVID-19 is restless legs syndrome during sleep, caused by polyneuropathy, which can develop in the post-Covid or acute period. A person experiences unpleasant sensations (pain, numbness) in the lower extremities, which is why he randomly moves his legs in his sleep in order to somehow alleviate this condition, and wakes up.
Patients who have recovered from COVID-19 experience asthenic and anxiety disorders.
The center has developed and implemented rehabilitation programs for survivors of COVID-19 and those with neurological complications. We have already examined 100 patients who presented with various sleep disorders after suffering a coronavirus infection. Now we are processing the data received, looking at which phases of sleep are disturbed, how often respiratory disorders occur, etc.
General practitioners note that elderly patients constantly complain of insomnia...
In fact, it may be pseudo-insomnia. Firstly, with age, the need for sleep decreases to 6–7 hours. Secondly, older people who do not work have a disrupted daily routine: they may take a nap at lunch or fall asleep at 8 pm. Of course, by 2 a.m. they have already slept, but waking up at this time is perceived as insomnia. That is, in older people, sleep may be fragmented. The total sleep time per day, however, is 6–7 hours, and this is enough in old age. Although even in this case they may not feel rested: poor general condition, depression, possibly anxiety-depressive disorders, and encephalopathy are taking their toll. People who worked night shifts suffer from insomnia due to a disorder in their circadian rhythms.
How does getting enough sleep contribute to good health?
Sleep plays an important role in the regulation of cellular processes, as well as humoral immunity. Lack of sleep can reduce the negative immune response and increase the risk of developing mental disorders.
The function of healthy sleep is anabolic, i.e. the synthesis of hormones, enzymes, proteins that restore the structure of the body’s tissues and thereby ensure an increase in life expectancy. The production of somatotropic hormone, which promotes protein synthesis and thus the growth and development of the body in childhood, ensures tissue regeneration in adults. Women have probably noticed: as soon as you get a good night's sleep, wrinkles smooth out.
In deep sleep, the cleansing function of the brain is carried out. Cleansing in the body occurs through lymphatic vessels, which are not found in the central nervous system. The central nervous system has a blood-brain barrier that completely protects it from harmful influences. Cleansing here occurs by washing away harmful substances and waste products of the brain with cerebrospinal fluid during the period of deep slow sleep. Accordingly, if slow sleep is not enough, the cleansing function is not performed, and a pathological protein, amyloid, accumulates. All this leads to impairments in memory and attention and ends in severe cognitive disorders and dementia.
How to diagnose and treat insomnia, including that caused by COVID-19? What should general practitioners pay attention to?
The most reliable way to diagnose sleep disorders is polysomnography. This is not a routine method, but it is quite accessible in large clinics. Our center has a sleep laboratory for 10 years. Anyone who suffers from a sleep disorder can get tested. The indication is determined by a doctor of any specialty. Polysomnography allows you to identify which sleep cycle is disturbed, monitor nighttime saturation, detect respiratory and cardiovascular pathology during sleep, monitor fluctuations in blood pressure, diagnose sleep apnea syndrome, restless legs syndrome, etc. We identify the main cause of sleep disorders - it is primary or arose as a result of pathology of internal organs or systems. After the examination, we select treatment.
Unfortunately, therapists sometimes underestimate the seriousness of the sleep disorder situation. You cannot prescribe a sleeping pill without understanding the cause of insomnia. The effect of different groups of sleeping pills is not taken into account.
Sleep disorders need to be approached differentially and the cause must be addressed.
The classification includes up to 50 types of insomnia, so their accurate diagnosis and adequate therapy are key.
The therapist must exclude diseases in which insomnia is a symptom. In addition, it is necessary to conduct psychotherapeutic testing to identify depression, anxiety, etc. An elderly patient can be asked to keep a sleep diary for some time to monitor whether he sleeps enough per day. A general practitioner can make a preliminary diagnosis and refer you to a specialist, including a somnologist.
Those who have had COVID-19, especially in severe form, develop asthenic and anxiety disorders, one of the symptoms of which is insomnia. Such patients should work with psychologists and psychotherapists. As a rule, complex treatment is necessary: restorative, relieving anxiety, fear, tension, as well as psychotherapeutic methods of correction.
Particular attention is paid to the administration of melatonin, which has been included in the protocols for the prevention and treatment of the initial manifestations of COVID-19 due to its immune protection properties. Melatonin is prescribed for insomnia, especially in older people, when its synthesis is insufficient.
Are valerian, chamomile, etc. effective for insomnia?
These are really good tools. You can normalize mild sleep disorders with the help of folk remedies, such as honey and milk at night.
Healthy foods are rich in tryptophan, the lack of which can lead to insomnia - turkey, bananas, cheese, sesame...
Sleep hygiene is mandatory: do not overeat at night, do not eat heavy, fatty foods in the evening, for example, red meat (the body continues to work, digesting food). Alcohol has a quick soporific effect, but its breakdown products, on the contrary, soon cause awakening.
What rare types of sleep disorders have you been treated with? Share cases from practice.
Notable cases of parasomnia are sleepwalking, sleep talking, nightmares, fears, sleep paralysis, etc. Also one of the most famous types is night eating syndrome, which can be a manifestation of an eating disorder. There were patients who got up at night to eat, and did this in a state of sleep, and when they woke up in the morning they did not remember anything.
REM sleep is called paradoxical because during this phase the brain works as actively as during wakefulness, and the muscles are completely relaxed.
When there is a delay in the transition from REM sleep to wakefulness, a person experiences a condition called sleep paralysis, or so-called. old witch syndrome. The person cannot move, and the brain is not fully awakened. In this case, nightmares arise. There is a legend: when dying, an old witch sits on a person’s chest and transfers her abilities. Sleep paralysis occurs during stress and emotional shock. When I was teaching at the university, one of my students conducted a survey among her classmates. It turned out that about 90% of students experienced sleep paralysis to varying degrees.
Patients with bruxism are often encountered. This is a serious disorder in which the teeth are erased by almost half. We refer such patients to orthodontists to have special mouth guards made.
In my practice, I also encountered sleepwalking syndrome, as well as cases of vocalization - laughing, humming in sleep, making other sounds.
Patients with hypersomnia were observed, when the duration of sleep significantly exceeds the norm or a person falls asleep at the most inopportune moment during the day amid a surge of emotions or laughter. One of the manifestations of such conditions is narcolepsy. This phenomenon has not been fully studied; a congenital deficiency of orexin-containing neurons involved in the regulation of sleep/wake cycles is revealed.
Another reason is the patient’s hidden psychological problems. So, we examined a girl who had a hidden conflict with her mother. To avoid quarrels, when her mother came home from work, the girl went to bed. Subsequently, this transformed into falling asleep during the day - during work and at other unexpected moments.
Each patient has to be dealt with individually; the causes of insomnia are very different. You need to constantly study and read, because every day there are a lot of mysteries in front of you. You come to work and every time you have to solve some kind of puzzle. This is a great responsibility.
Signs
The phenomenon of sleep stupor was studied by Allan Chain, a psychologist at the Canadian University of Waterloo, and his colleagues. These researchers divided the anamnestic data on the experiences accompanying the phenomenon into three independent groups:
Hallucinations when falling asleep
- fear, anxiety, feeling of someone else's presence, hallucinations (visual and auditory);
- “unusual out-of-body sensations”: flying, soaring, feeling of bliss;
- difficulty breathing, pressure on the chest, chest pain.
The most common sensations experienced by patients were anxiety and the experience of someone else's presence. A physiological explanation can be given for this: the sensations are caused by the suppression of muscle tone during REM sleep, and the visions are an attempt by the brain to identify the basis for atypical experiences.
The second group includes:
- feelings of upliftment;
- lifting off the ground;
- slip;
- flight;
- spinning;
- moving through a narrow tunnel.
All these sensations are explained by the fact that the vestibular apparatus remains active during REM sleep. Information about the position that the body occupies does not enter the brain, which is what is felt like flight, ascent. Unusual feelings accompanying the phenomenon of sleepy stupor can become a source of joyful emotions, even bliss.
Signs of this insomnia are usually observed at the time of getting up, and occasionally they can appear at the time of going to bed. Many patients feel as if their chest is tight and it is difficult to breathe. In reality they are breathing normally.
Some patients are able to open their eyes during stupor, which cannot be done in normal sleep. The feeling that someone is nearby often accompanies this phenomenon, in some cases even hallucinations occur: people hear or see a creature intending to harm them and do not know what to do.
Syndromes of moving limbs in sleep and restless legs: “I broke my wife’s nose”
Another common disease now is sleep hyperkinesis. Behind the complex name lies a phenomenon familiar to many - when falling asleep, a person involuntarily shudders
, it ends when he falls asleep. This symptom occurs at the border of sleep phases, when falling asleep or waking up. The motor part of the cerebral cortex works too quickly - due to the lack of smoothness, such jerks occur.
If the situation does not bother the patient and the person lying next to him in bed, then the symptom is considered the line between normal and pathology. However, sometimes this shuddering occurs so violently that the bedmate may end up on the floor. There was an interesting case: a young man returned from the army, where they clearly had trouble waking him up. I started living with a girl, and a problem arose. Involuntary contractions did not occur when he fell asleep, but, on the contrary, when he woke up (this happens). This happened so expressively that the girl was afraid to approach her partner in the morning, especially after he woke up again and broke her nose. From some point on, she woke him up exclusively with a mop
. The guys realized that the situation was extremely unhealthy and came to see me.
We figured out the problem - everything turned out to be quite simple and sad. The guy was slightly bullied in the army, and he developed a defensive reaction, which he brought as a baggage of army experience to civilian life. The prescribed treatment completely eliminated this condition.
What is described above is sometimes confused with “restless legs syndrome” - a deviation when a person, lying down, experiences discomfort in the lower extremities, as if he cannot find a place for them, they “twist” and “stretch”. This disease is the equivalent of Parkinson's disease
: unpleasant sensations arise due to a deficiency in dopamine production. In a neglected state, discomfort can begin not only at night, but also at any time when the legs are at rest. People suffer for years, but in fact the problem is most often solved in a couple of days.
Folk interpretations of sleepy stupor
Scientific study of this phenomenon has begun recently. Paralysis that occurs during sleep really frightens a person, especially for the first time. The sleeper does not understand why this happens and turns to various folk interpretations and superstitions.
Cambridge University scientist Baland Jalal believes that in such a situation, the human brain and rational consciousness try to find a similar experience to explain what is happening, connecting personal memories, as well as established cultural attitudes, superstitions and traditions. It is for this reason that you see demons, aliens, ghosts and characters from childhood nightmares who want to attack.
For many years of human history, nighttime evil spirits have been blamed for attacks of sleep paralysis.
Explanation of the condition among different peoples
German legends describe a mare that sits on the chest of a sleeping man at night. In Norway, Denmark, Iceland, and also in France, they believed in demons (mar) who came in the dark to strangle a person. Folklore mentions incubi and succubi - night demons who want to have sex with the sleeping person.
In Russian legends, sleepy stupor is associated with the domovoi (“domovoy strangles”), as well as with maars and other terrible undead. The Slavs believed that these creatures jumped on a sleeping person to predict upcoming important events.
Muslims have long attributed sleep stupor to the actions of jinn. The Basques have a demon named Inguma: he comes to people at night and grabs sleeping people by the throat, causing chilling horror. The Japanese believe that an attack of sleepy stupor is caused by a huge demon Kanashibari, which lowers its heavy leg onto the chest of a sleeping person.
Orthodoxy tends to struggle with fantastic explanations for pathological conditions that cause horror. Psychics explain sleep paralysis as the exit of a person’s soul in order to move in time and space.
Diagnostics
The typical clinical picture makes it easy to make the correct diagnosis. The patient is examined during repeated episodes of paralysis, in order to exclude psychiatric and neurological diseases that need to be treated. Consultations with a neurologist, a psychiatrist, polysomnography, and an MSLT test are required.
Neurologist consultation
Usually there are no peculiarities in the neurological status. Sometimes there is lability of emotions, asthenia as a result of background sleep disorders, overwork.
Polysomnography
An episode of decreased muscle tone is recorded via video surveillance. A motionless patient is observed, with open eyes and an expression of horror on his face. Cardiac monitoring reveals changes characteristic of REM sleep (rapid heart rate, shallow and rapid breathing).
You can distinguish the loss of muscle tone during sleep from paroxysms of epilepsy using electroencephalography.
MSLT test
Indicated for suspected excessive daytime sleepiness (narcolepsy). This pathology is confirmed by a shortening of the latency period and the detection of more than 2 episodes of daytime falling asleep.
Examination by a psychiatrist
The doctor talks with the patient, observing his behavior, and conducts psychological testing. An examination by this specialist will help rule out psychiatric pathology. The differential diagnostic search includes other sleep disorders, epilepsy, and psychopathology.
Attacks of daytime sleepiness are accompanied by a disease such as narcolepsy. Somnambulism develops without loss of muscle tone; a person walks and moves in his sleep without regaining consciousness. This is a phenomenon diametrically opposed to sleepy stupor. EEG excludes epilepsy, polysomnography excludes sleep apnea syndrome.
Symptomatic treatment
First of all, patients with narcolepsy are advised to lead a certain lifestyle:
- give up “heavy” foods, caffeine, alcohol, smoking;
- observe a sleep schedule - reduce daytime sleep, increase nighttime sleep, go to bed and get up at the same time;
- doing physical exercise;
- plan a schedule of your actions so that while performing certain actions (for example, driving a car) you are especially vigilant and careful. It is better to have someone nearby during this period.
To control sleep disturbances, drowsiness, and avoid hallucinations, the doctor prescribes certain medications to the patient - stimulants, antidepressants, etc. His recommendations should be strictly followed and any problem or change should be reported immediately.
Good news came out not long ago. Based on scientists’ assertion that one of the causes of narcolepsy is a lack of orexin in the brain (discussed above), a nasal spray containing it was developed. So far the drug has only been tested on monkeys, but after using it the animals were alert even with a lack of sleep. The military is interested in the development, but there is hope that it will reach the sick!
Behavioral therapy is also indicated. Family members of a person suffering from narcolepsy, as well as colleagues and superiors, should know about his illness - the attending physician should be the first to inform about this, and the patient himself should inform the rest. This makes it possible to avoid a lot of misunderstandings - those around you will understand the patient’s behavior and not think that he is deliberately shirking work, is lazy, becomes depressed, or suffers from a mental disorder.
Relatives will support the narcoleptic relative and help cope with the symptoms of the pathology. As for work, the employer, if possible, will create certain conditions if it is interested in such an employee. If not, then the patient will have to look for another source of income where his problem will not interfere with the performance of his official duties.
Parents of a child with such a disease should warn teachers about it. Teachers will definitely take measures to ensure that the student is not ridiculed, the educational process does not suffer, etc. The diagnosis will not be an obstacle to good performance and education.
How to get rid of sleep paralysis
Over time, paroxysms during sleep disappear on their own; they are not dangerous and do not lead to death. Medicine gives a negative answer to the question of whether you can die from sleep paralysis. As a treatment, the doctor can talk with the patient about the factors that cause episodes of sleep paralysis, give recommendations on maintaining a rest and work schedule, and on relaxation before going to bed at night.
Drug therapy is indicated in case of detection of psychopathology or neurotic disorders. The following tips will help prevent new paroxysms of sleep paralysis.
Compliance with the regime
Both mental and physical stress should be avoided and you should rest on time. You need to set aside time every day for walks and exercise.
Getting enough sleep
You should go to sleep and wake up at the same time intervals. You need to sleep at least eight hours.
Relaxation before a night's rest
In the evening, you need to avoid mental overload, working at the computer, watching TV: all this activates, rather than calms, the activity of the central nervous system.
It is very relaxing to listen to calm music, drink soothing infusions, light massage, aroma baths, herbal baths.
Rise on schedule
Only spontaneous awakening can be accompanied by a paroxysm of paralysis. To avoid this phenomenon, you need to get up when the alarm rings or ask someone to wake you up. If the patient understands the mechanics of the development of muscle paralysis during sleep, working with a psychologist can help.
During the sessions, the patient masters techniques for quickly recovering from paroxysms and reducing emotional experiences. It is advisable to learn relaxation techniques that you can practice on your own to achieve lucid sleep.
How to help yourself during an attack
The duration of sleep paralysis lasts several seconds or minutes. During this time, nothing terrible happens to the person, but the condition is not the most pleasant. In night paralysis, a person can become aware of what has happened to him if, for example, he is informed about the possibility of such a state or has already experienced it before. Unpleasant and even terrible sensations during paralysis do not please anyone and do not give much pleasure, therefore, to get out of this state on your own, you can take some actions:
- Realize that this state and everything that happens is just the influence of hallucinations. The resulting condition does not occur in reality, but is just a slight disruption of brain activity.
- Try to relax, relax all your muscles. Fear forces a person to tense the whole body more, which only worsens the convulsive and constrictive state.
- Try moving your muscles, such as moving your tongue, moving your lips, blinking, rolling your eyes, or using your fingers and toes.
- If the muscles still do not obey you, distract yourself from what is happening with brain activity in the form of counting, pronouncing words, letters, concepts or other systemic formations.
When recovering from sleep paralysis, it is important to try to gain some ability to move the body.
